Exam 4: NUR 209 Medical-Surgical Nursing II
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Content Focus :
Advanced Neuro-Trauma, Stroke Rehabilitation & Critical Care Respiratory Emergencies
Q1: A 28-year-old male sustains a temporal bone fracture. He loses consciousness briefly, then
appears alert and oriented, but rapidly deteriorates with a fixed dilated pupil. Which condition is
suspected?
A. Subdural hematoma
B. Subarachnoid hemorrhage
C. Intracerebral hemorrhage
D. Epidural hematoma
Correct Answer: D
Rationale: Epidural hematoma classically presents with a lucid interval after head trauma
followed by rapid deterioration due to arterial bleeding from the middle meningeal artery. The
fixed dilated pupil indicates ipsilateral cranial nerve III compression from uncal herniation.
Correct because this presentation is pathognomonic for epidural hematoma requiring emergent
surgical evacuation.
,Q2: A patient with a basilar skull fracture has clear fluid draining from the nose. The nurse
places a sterile gauze pad under the nose and observes a clear ring surrounding a central blood
spot. Which test confirms cerebrospinal fluid?
A. Beta-2 transferrin assay
B. Glucose oxidase test
C. Gram stain culture
D. Hemoglobin electrophoresis
Correct Answer: A
Rationale: Beta-2 transferrin is a protein found exclusively in cerebrospinal fluid and perilymph,
making it the definitive diagnostic test for CSF rhinorrhea. The halo sign is suggestive but not
definitive because mucus and saliva can also produce similar patterns. Correct because beta-2
transferrin is the gold standard confirmatory test for cerebrospinal fluid leakage.
Q3: A patient with sepsis develops severe hypoxemia refractory to 100% oxygen. Chest X-ray
shows bilateral diffuse infiltrates. Pulmonary capillary wedge pressure is 12 mmHg. Which
condition is present?
A. Cardiogenic pulmonary edema
B. Pneumonia
C. Acute respiratory distress syndrome
D. Pulmonary embolism
Correct Answer: C
Rationale: Acute respiratory distress syndrome is characterized by refractory hypoxemia,
bilateral diffuse infiltrates on chest imaging, and a pulmonary capillary wedge pressure below 18
mmHg excluding cardiogenic causes. The non-cardiogenic pulmonary edema results from
increased alveolar-capillary permeability due to systemic inflammation. Correct because these
findings fulfill the Berlin criteria for acute respiratory distress syndrome.
Q4: A patient with myasthenia gravis presents with severe generalized weakness, ptosis, and
respiratory distress after missing several doses of pyridostigmine. Which type of crisis is
present?
A. Cholinergic crisis
B. Myasthenic crisis
C. Thyroid storm
D. Adrenal crisis
, Correct Answer: B
Rationale: Myasthenic crisis results from undermedication with acetylcholinesterase inhibitors,
producing worsening muscle weakness and respiratory compromise due to insufficient
acetylcholine at the neuromuscular junction. The Tensilon test would improve symptoms,
confirming inadequate cholinergic stimulation. Correct because missed doses of pyridostigmine
leading to severe weakness and respiratory distress defines myasthenic crisis.
Q5: A patient with a temporal bone fracture presents with classic signs of epidural hematoma.
Which clinical features support this diagnosis? Select all that apply.
A. Gradual onset of symptoms over 72 hours
B. Brief loss of consciousness followed by a lucid interval
C. Rapid deterioration with decreased level of consciousness
D. Pinpoint pupils bilaterally
E. Ipsilateral fixed and dilated pupil
Correct Answer: B, C, E
Rationale: The lucid interval is the hallmark of epidural hematoma, during which the patient
appears normal before arterial bleeding causes rapid expansion of the clot. Rapid deterioration
occurs as the hematoma increases intracranial pressure and compromises cerebral perfusion. An
ipsilateral fixed and dilated pupil indicates compression of the oculomotor nerve from uncal
herniation, which is a neurosurgical emergency. Correct because these three findings constitute
the classic triad of epidural hematoma progression.
Q6: A patient with a basilar skull fracture has clear fluid draining from the ear. Which nursing
intervention is appropriate?
A. Place a loose sterile collection pad over the ear
B. Pack the ear canal with sterile gauze
C. Insert a cotton-tipped applicator into the ear canal
D. Position the patient flat without head elevation
Correct Answer: A
Rationale: A loose sterile collection pad allows cerebrospinal fluid to drain freely without
creating a reservoir for bacterial growth or increasing intracranial pressure. Packing the ear or
nose is contraindicated because it obstructs drainage, promotes infection, and can force bacteria
into the cranial vault. Correct because allowing free drainage with a loose collection pad is the
standard of care for CSF otorrhea.
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Content Focus :
Advanced Neuro-Trauma, Stroke Rehabilitation & Critical Care Respiratory Emergencies
Q1: A 28-year-old male sustains a temporal bone fracture. He loses consciousness briefly, then
appears alert and oriented, but rapidly deteriorates with a fixed dilated pupil. Which condition is
suspected?
A. Subdural hematoma
B. Subarachnoid hemorrhage
C. Intracerebral hemorrhage
D. Epidural hematoma
Correct Answer: D
Rationale: Epidural hematoma classically presents with a lucid interval after head trauma
followed by rapid deterioration due to arterial bleeding from the middle meningeal artery. The
fixed dilated pupil indicates ipsilateral cranial nerve III compression from uncal herniation.
Correct because this presentation is pathognomonic for epidural hematoma requiring emergent
surgical evacuation.
,Q2: A patient with a basilar skull fracture has clear fluid draining from the nose. The nurse
places a sterile gauze pad under the nose and observes a clear ring surrounding a central blood
spot. Which test confirms cerebrospinal fluid?
A. Beta-2 transferrin assay
B. Glucose oxidase test
C. Gram stain culture
D. Hemoglobin electrophoresis
Correct Answer: A
Rationale: Beta-2 transferrin is a protein found exclusively in cerebrospinal fluid and perilymph,
making it the definitive diagnostic test for CSF rhinorrhea. The halo sign is suggestive but not
definitive because mucus and saliva can also produce similar patterns. Correct because beta-2
transferrin is the gold standard confirmatory test for cerebrospinal fluid leakage.
Q3: A patient with sepsis develops severe hypoxemia refractory to 100% oxygen. Chest X-ray
shows bilateral diffuse infiltrates. Pulmonary capillary wedge pressure is 12 mmHg. Which
condition is present?
A. Cardiogenic pulmonary edema
B. Pneumonia
C. Acute respiratory distress syndrome
D. Pulmonary embolism
Correct Answer: C
Rationale: Acute respiratory distress syndrome is characterized by refractory hypoxemia,
bilateral diffuse infiltrates on chest imaging, and a pulmonary capillary wedge pressure below 18
mmHg excluding cardiogenic causes. The non-cardiogenic pulmonary edema results from
increased alveolar-capillary permeability due to systemic inflammation. Correct because these
findings fulfill the Berlin criteria for acute respiratory distress syndrome.
Q4: A patient with myasthenia gravis presents with severe generalized weakness, ptosis, and
respiratory distress after missing several doses of pyridostigmine. Which type of crisis is
present?
A. Cholinergic crisis
B. Myasthenic crisis
C. Thyroid storm
D. Adrenal crisis
, Correct Answer: B
Rationale: Myasthenic crisis results from undermedication with acetylcholinesterase inhibitors,
producing worsening muscle weakness and respiratory compromise due to insufficient
acetylcholine at the neuromuscular junction. The Tensilon test would improve symptoms,
confirming inadequate cholinergic stimulation. Correct because missed doses of pyridostigmine
leading to severe weakness and respiratory distress defines myasthenic crisis.
Q5: A patient with a temporal bone fracture presents with classic signs of epidural hematoma.
Which clinical features support this diagnosis? Select all that apply.
A. Gradual onset of symptoms over 72 hours
B. Brief loss of consciousness followed by a lucid interval
C. Rapid deterioration with decreased level of consciousness
D. Pinpoint pupils bilaterally
E. Ipsilateral fixed and dilated pupil
Correct Answer: B, C, E
Rationale: The lucid interval is the hallmark of epidural hematoma, during which the patient
appears normal before arterial bleeding causes rapid expansion of the clot. Rapid deterioration
occurs as the hematoma increases intracranial pressure and compromises cerebral perfusion. An
ipsilateral fixed and dilated pupil indicates compression of the oculomotor nerve from uncal
herniation, which is a neurosurgical emergency. Correct because these three findings constitute
the classic triad of epidural hematoma progression.
Q6: A patient with a basilar skull fracture has clear fluid draining from the ear. Which nursing
intervention is appropriate?
A. Place a loose sterile collection pad over the ear
B. Pack the ear canal with sterile gauze
C. Insert a cotton-tipped applicator into the ear canal
D. Position the patient flat without head elevation
Correct Answer: A
Rationale: A loose sterile collection pad allows cerebrospinal fluid to drain freely without
creating a reservoir for bacterial growth or increasing intracranial pressure. Packing the ear or
nose is contraindicated because it obstructs drainage, promotes infection, and can force bacteria
into the cranial vault. Correct because allowing free drainage with a loose collection pad is the
standard of care for CSF otorrhea.
